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FIN24.COM Government does not believe it can wait until the healthcare system is improved before implementing national health insurance, Health Minister Aaron Motsoaledi has said.

The minister was speaking at a briefing at Tuynhuys, Parliament, where the report of the outcomes of the presidential health summit, held late last year, was released.

During his address on Tuesday, Motsoaledi said government would be taking significant steps towards implementing universal healthcare.

Last week, president Cyril Ramaphosa said that the National Health Insurance Bill would be tabled before Parliament this year.

NHI will ensure that South Africans can receive free health services at the point of care at both public and private quality-accredited healthcare service providers, Motsoaledi said.

NHI is a proposed state-run health financing system that aims to pool funds to provide access to quality health services for all South Africans regardless of their economic status.

Mostoaledi commented that most of the criticism of NHI is that people are calling for the current healthcare crisis to be addressed before NHI should be implemented.

'A lifelong thing'

"[There are] many people who are worried, or believe we are not ready, and believe we must improve public healthcare first before implementing NHI… We reject that view in totality," Mostoaledi said.

"At no stage of any nation would anyone stand up and say the public healthcare system has finally been adequately improved. It is a lifelong thing. Even in advanced economies, no one can say they have successfully improved the healthcare system and now we will move onto the next step."

Mostoaledi referred to the UK, which implemented universal healthcare 70 years ago, a few years after the war. "At the time, the healthcare system did not exist. Britain was battered by the Second World War. I was informed that Britain was on the brink of bankruptcy when they introduced universal healthcare," he said.

"Even up until today, they (Britain) are still improving the healthcare system."

Motsoaledi said that Britain had not stopped improving its healthcare system over the past 70 years. He also used SA as an example, referring to when government started rolling out anti-retroviral treatment for HIV infected patients. If government had to wait for the healthcare system to be more stable before doing that, then it would have collapsed by the sheer amount of people who would have become ill due to a lack of treatment, he argued.

Motsoaledi said that government would continue to solve problems as they occurred, and do the same with NHI.

DIAMOND FIELDS ADVERTISER In his State of the Nation Address last week, President Cyril Ramaphosa told parliament that: "This year, we will take a significant step towards universal access to quality health care for all South Africans.

"After extensive consultation, the NHI Bill will soon be ready for submission to Parliament. The NHI will enable South Africans to receive free services at the point of care in public and private quality accredited health facilities.

"By applying the principle of social solidarity and cross subsidisation, we aim to reduce inequality in access to health care.

"Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement War Room in the Presidency consisting of various key departments to address the crisis in the public health system while preparing for the implementation of the NHI.

"We have a funded national quality health improvement plan to improve every clinic and hospital that will be contracted by the NHI. By introducing the NHI together with a multi-pronged quality improvement programme for public health facilities, we are working towards a massive change in the health care experience of South Africans."

This commitment to the nation, by the highest office in the land, has assured even the doubting Thomases of the government's commitment to the implementation of the National Health Insurance (NHI).

However, despite our concerted efforts to explain the concept of the NHI, there are sceptics who argue that the plan is unaffordable and that the government should first address the serious challenges in the public health care sector before rolling out the Universal Health Coverage (UHC) plan.

The mistake that these sceptics make is that they believe that NHI would be based on the current cost of private health care, which is a fallacy.

We are quite certain of the affordability and sustainability of NHI because our plan will be anchored on Primary Health Care.

Primary health care has 3 components: • Prevention of diseases • Promotion of health and healthy lifestyle • The entry point into the health care system if you are sick, should not be at tertiary hospitals or specialist level but should be at the primary health care level, meaning clinics, GPs and allied health professionals at non specialist levels.

The common practice that has developed over years in our country is that when people get sick, their first point of call is a hospital. They have very low regard for their local clinics. In fact, many of our people perceive clinics as institutions where children are immunised and get weighed only.

Under NHI, we will change this. Primary healthcare is the heart beat of NHI. But even more importantly, we want to overhaul the system. The current system is more curative.

In other words, we wait for you to be ill and treat you in our hospitals. We want to roll out a massive public education on healthcare to promote a healthy lifestyle.

If you look at Cuba, where we thousands of our doctors have been trained, they have eliminated many diseases not because they have lots of resources, but because they focused on primary health care. This is the way to go.

Currently our hospitals are not struggling to cope with the burden of diseases. Many of these diseases are preventable and if we can focus on educating our people about how to prevent them and educate them to test for early detection, we will go a long way to reduce the bur den of disease in our hospitals.

Through NHI, we want to empower our people so that they are not just passive recipients of health care service but that they become active participants in shaping their state of health. We have already started educating members of the public about the negative effects on health of things such as tobacco, alcohol, sugar and salt.

People should also be taught to appreciate the need to be physical fit and to control their weight so that they can contribute to staying healthy and keeping certain diseases at bay.

Primary health care is sustainable and affordable. People are able to use health care at the entry level. If you have flu and consult a specialist, you are going to pay an arm and a leg, unnecessarily for such a simple and common aliment.

It is like consulting an attorney or briefing a senior counsel. Both these professionals are lawyers but do not operate at the same level and as such their rates would be different. Imagine you have your goat stolen but you brief a senior counsel to pursue the matter of compensation for your goat. The legal costs due to the Senior Counsel will be much more than the value of the goat.

This is just flushing money down the drain. The good thing is that the world is starting to wake up to the fact that primary health care approach is the way to go. Without Primary Health Care, any UHC plan would experience serious financial difficulties.

Without an effective Primary Health Care system, the tertiary health care would be over burdened by simple things that should have been dealt with at primary health care level. Many of our tertiary hospitals are over loaded with work because they are treating too many patients who should not be there in the first place. You find hundreds of patients going to Chris Hani Baragwanath Academic Hospital to get treatment of minor illnesses such as flu.

This is certainly not sustainable. As health professionals, we know that health is not just the absence of disease but a state of good physical, mental social well-being. This has to be extended to everybody and this right cannot only be reserved to those who have the financial means. This is why we have no option but to move with speed to implement the NHI.

The former health minister of Ethiopia, who is the current Director General of the World Health Organisation Dr Tedros Adhanom Ghebreyesus, once shared with me how in his native country they had been achieve much better health out-comes such as reducing maternal mortality than South Africa despite the fact that South Africa has much more advanced hospitals than Ethiopia.

His argument was simple. They used primary health care, deploying.com munity health workers throughout the country. Our current system is actually sick care not health care. In other words, our approach is taking care of the sick. Those who believe that they are healthy, they are not part of the healthcare system. They first have to be sick first to be part of our system.

But when we apply primary health care system, those who consider themselves to be healthy, are part of the system.

They have to undergo screening to avoid going to the hospital when they are very sick. We are encouraged by the words of President Ramaphosa that the NHI bill will be going to parliament soon.

We have no option but to deliver on this Constitutional mandate of ensuring that we provide quality and affordable health care to all our people regardless of their economic or social status.

DAILY DISPATCH Doctors have expressed concern at a new rule introduced by Discovery medical aid in 2019 that some of its members have to use day clinics for certain procedures.

Members of the Discovery saver, smart, key-care, core and priority plans have to use day hospitals where patients can not stay overnight or pay hefty co-payments to go to an ordinary hospital.

Discovery chief executive Jonathan Broomberg said in an e mail to Times Select: "In the US, for example, up to 90% of all surgical procedures are per formed on a same day basis, whereas the equivalent figure in South Africa is below 15%.

"South African private health care is lagging well behind global trends in moving surgery to more cost effective settings." But local doctors say the healthcare system here cannot be compared to the US.

The main concerns about day hospitals are that patients can not be monitored overnight after procedures, the day hospitals do not have intensive care units, and many are not equipped to do blood transfusions.

Doctors say they were not consulted before the decision was made, while many of the day hospitals are not up to the appropriate standard to ensure operations take place safely, or have the equipment needed.

He said Discovery did not assess whether the day hospitals had the correct equipment or staff for a procedure.

"ENT theatre requires very expensive instruments and trained staff."

Joseph said doctors had to observe patients who had surgery on their airways to en sure they did not have.com plications that compromised breathing. This means operations at a day hospital must be done in the morning so patients can be watched closely in the afternoon. "Many ENT day cases must be done in the mornings for patient safety.

"Discovery did not check whether the day clinics have morning lists availability," Joseph said.

A Facebook post by paediatric pulmonologist Fiona Kritizinger, which has been widely circulated among doctors on WhatsApp, drives the point home.

"We do airway endoscopies on babies and children because their airway is at risk or because they have significant lung dis ease," she wrote.

"Performing such high risk procedures on babies and children in a facility with no aftercare and no ICU back up will never be safe, no matter how Discovery spins this story regarding what happens in other countries."

She said there was not a single day hospital in the Western Cape with equipment to perform surgeries Discovery wanted to be done in day hospitals.

In response, Discovery's Broomberg said doctors could ask for exceptions to be made in these cases.

Specialist physician Adri Kok said there was a real risk that complications from surgery could not be dealt with by a day hospital.

"What if a child has a tonsillectomy and bleeds to death? This happened last year in a day hospital," Kok said.

A day hospital does not always have the skilled resus citation staff or an ICU and may not have blood for transfusions, she said.

Surgeon Stefaan Bouwer said equipment for ENT surgery cost up to R3m and some day hospitals could not afford this.

However, Discovery said this was not true. "Day clinics are accredited in South Africa, and the procedures on the Day Surgery Network list are aligned with those of the Day Hospital Association of South Africa."

Broomberg said: "Day surgery centres have been shown to be safer and more cost effective when operated efficiently.

"The list of procedures that are performed in the Discovery Health medical scheme day surgery network has been approved by the Council for Medical Schemes."

Joseph said: "Ear, nose and throat societies are not opposed to day clinics. We use many currently. But we need to en sure that the day clinic can deliver on quality care.

"The Discovery modus operandi is to expose patients to risk and or poorer quality and rely on specialists to correct this by checking the day clinics' services and facilities."

Joseph said ENT doctors were now checking every day clinic that had to be used to ensure they met safety standards.

Broomberg said it was adjusting its approved hospital list in consultation with doctors.

But Kok said SA could not be compared to the US where most operations took place in day hospitals.

She said the US had better medical support at day hospitals and more doctors to travel between day and acute hospitals.

Kok said she was a medico legal witness in 2018, in a case of a patient who had a hysterectomy at a day clinic. The patient began to bleed internally and the gynaecologist did not pick up the internal bleeding in time. By the time the doctor realised it, the day clinic did not have blood for a transfusion. The patient almost died.

Broomberg said doctors could apply for exemptions if they needed to perform surgery on a patient in an acute hospital owing to the risks.

MEDICAL BRIEF Health Minister DR Aaron Motsoaledi says in an Eyewitness News report that he is disappointed and highly distressed that some interns and doctors who started work in last month have still not received their January salaries.

The report says the South African Medical Association (Sama) had had reached an agreement with the administrations of health sectors in various provinces that salaries would be paid by this past week, however, some doctors have been left hanging and have still not received their payments.

Motsoaledi says he doesn’t understand how something like this could happen. “The issue of the payment of salaries should not be a complex one. All that was left was to capture the details of each and every doctor in each province and start paying them. We are so disappointed.”

More than 400 interns and community service doctors have not been paid their January salaries, according to the Gauteng Health Department. Bhekisisa reports that junior doctors are supposed to be paid on the last day of the month. However, when the department failed to pay out last month, it assured new graduates that they would be paid by 7 February.

But, the report says, interns and community service doctors from at least 10 hospitals in the province said they were still without payment as of late Thursday. Although some doctors received a courtesy call letting them know salaries would be further delayed, many heard nothing at all from hospital human resources departments.

BUSINESS DAY The Special Investigating Unit (SIU) is poised to launch an investigation into possible mal administration and corruption at the Council for Medical Schemes CMS, the watchdog agency for the country's medical schemes industry.

The probe is set to send a ripple throughout the multibillion rand sector and is likely to extend into the private sector.

The development takes place in parallel with an investigation the CMS plans to conduct into allegations of corruption against the head of its complaints and investigations unit head, Stephen Mmatli, whom it sus pended last week.

The CMS's move has already shaken the industry, as it raises questions whether it has been turning a blind eye to matters that should have been scrutinised, or has directed inappropriate inspections at schemes and administrators.

SIU head Andy Mothibi told Business Day on Tuesday that whistle blowers approached the unit alleging impropriety at the CMS's compliance and investigations department.

He declined to provide details, saying only that they related to the processes handled by the department and included the allegation that an inspection had been stopped for no apparent reason.

"I'm anticipating the investigation into the CMS could point further, into private sector players," Mothibi said.

The SIU is expected to have prepared a draft proclamation for President Cyril Ramaphosa to sign by the end of the week, said Mothibi.

The draft proclamation is to be submitted to the justice minister early next week, and then to the presidency, he said. Once an official proclamation has been published in the government gazette, the SIU will be authorised to begin probing the affairs of the CMS. Medical schemes are not for profit organisations that pool members' funds for future medical expenses, which are largely provided in the private health care sector.

There were a total of 8.87 million medical scheme beneficiaries in 2017, who collectively paid contributions of about R180bn, according to the council's 2017/18 annual report.

The CMS issued a circular to industry stakeholders on Friday, announcing that it had placed Mmatli on precautionary sus pension pending the outcome of an investigation into alleged corruption and misconduct.

"We received anonymous tip offs alleging, among other things, that Mr Mmatli has been involved in corrupt relationships with organisations regulated by the CMS. Secondly, that he has deliberately misled the council to take decisions in favour of those organisations and benefited financially in return," the CMS said in the circular.

No other CMS employees have been suspended. Mmatli's lawyer, Hope Chaane, said his client would oppose his suspension as Sipho Kabane, the acting registrar of the CMS, had failed to provide him with sufficient detail in his notice of intention to suspend his client.

This would have enabled him to defend himself and offer reasons as to why he should not be suspended.

POLITICS WEB Union says there will be an increased number of nurses, doctors and other health care workers.

The National Education, Health and Allied Workers’ Union [NEHAWU] have been pioneers of the National Health Insurance [NHI]. The NHI will provide access to health care to everyone regardless of their socio economic status as the current two tier system has resulted to deeply entrenched inequalities. The article by the private health care sector on how the implementation of the NHI will result to job losses doesn’t come as a surprise as the NHI Bill is a threat to their business.

The private sector is making an argument that the three JSE listed hospitals contribute about R55.5bn to GDP a year and the implementation of the NHI will result to Job losses of about 99.600. One then needs to first understand how many people or citizens are benefiting from this private health care and its contribution to GDP. Private sector spends 4.4% of GDP on health which benefits only 16% of the population, while the public sector spends 4.1% of GDP on health care for the remaining 84% of the population. This abnormality cannot continue to be accepted. The marginalised is not benefiting from this private sector contribution. The subsidy that the private health sector receives from government through contracting is supposed to improve social welfare of the majority and currently it is not.

The argument of Job losses is from the fear of losing government support as this means increased cost to them. For the private sector, increased cost leads to the laying off of workers in order for them to save their profits. Private Public engagement is not denied, even the constitution also allows for private participation in economy. But its contribution should results to improved social welfare. The NHI Bill does make an indication on the private sector involvement in the NHI. There are services of the private sector that the state will still for the implementation of the NHI. In his SONA President Cyril Ramaphosa addressed that they have a funded national quality health improvement plan to improve every clinic and hospital that will be contracted by the NHI.

This infrastructure development means using the services of the private sector in building, improving and maintaining these clinics and hospitals. Technological developments, machines will also require the services of the private health care. The conclusion that the NHI will result to job losses in the private sector cannot be valid if government would still be using their services.

The NHI bill also addresses the problem of human resource shortage in the public health care for a successful implementation of the NHI. This means increased number of Nurses, Doctors and other health care workers. The job summit addressed the issue of retrenchment and the resolution was made that they won’t be any retrenchments. The absorption of the Community Health Care workers to form part of government employees is one of the human resource developments that has been achieved towards the implementation of the NHI.

The second argument is on price regulation, and they saying it will also result to job losses. Price regulation is meant to allow for direct economic intervention and manage affordability of health care and create competition. With this issue of price regulation the Private sector is concerned more about loss of profit or reduced profits and less concerned about job losses. Price regulation by government will mean the private sector will lose its power to control prices. The abnormal profits that the private sector has been making over the years is a result of lack of price regulation which led to the three big hospitals monopolising the market. Health care has become a commodity that can only be purchased by those who can afford it and this is against section 27 of the constitution which provides for the right to health care to everyone.

BUSINESS DAY President Cyril Ramaphosa's ambitions of devising a plan for fixing the health system have once again been delayed, as participants from 2018's health summit say they need more time to do a proper job.

Ramaphosa convened the two day summit in late October, where delegates discussed ways to tackle the crisis in SA's health system. The high level gathering drew 600 delegates from the public and private sectors, and ended with a promise to craft a blueprint for tackling the problems in the health care sector, which has seen services virtually collapse in many parts of the country.

The summit ended with a promise to craft a health.com pact by December 10, but that deadline was moved to the end of January 2019 after some stakeholders, including health care professionals, said the time frame was too short. It has now emerged that work on the compact, which is expected to contain concrete steps for improving SA's health system, is still under way.

"We have given ourselves more time to do this properly, because we think it is important to find solutions we all support and can action. We are looking for tangible, action oriented out comes," said Business Unity SA (Busa) CEO Tanya Cohen.

Busa is one of the key constituents represented on the steering committee driving the process to craft the compact.

"What we haven't done is engage on the legislation that is before the National Economic Development and Labour Council and will go to parliament. We have been focusing on the cri sis," she said, referring to the National Health Insurance NHI Bill, which contains the first legal steps for realising the government's ambitions of universal health coverage.

Cohen made her remarks at a press briefing called by the presidency to report back on the work of the health summit. In a speech delivered on his behalf by health minister Aaron Motsoaledi, Ramaphosa said that improving the health system and introducing NHI went hand in hand, describing them as "two sides of the same coin".

NHI aims to provide quality health services to everyone that is free at the point of delivery and is founded on the social solidarity principle that the rich and healthy subsidise the poor and the sick. "Repairing our national health system is an endeavour that requires the input, involvement and innovation of all role players who understand that good health makes for a good life and a good economy."

Motsoaledi would not be drawn into a discussion on the NHI bill, which was discussed at the cabinet's most recent meeting on January 30. It requires cabinet approval before it can be submitted to parliament, and processed by SA's legislators.

MEDICAL BRIEF President Cyril Ramaphosa created confusion with a remark about the proposed National Health Insurance (NHI) during his State of the Nation address, health experts are quoted in The Times as saying. The report says those surveyed said his comments about the NHI appeared to contradict what the NHI Bill states – but it could also just be proof of the incoherence of the NHI policy.

Elsabe Klinck, a lawyer who specialises in healthcare, said in the report that the president’s remarks that NHI will be rolled out while clinics and hospitals are improved, was different from what the bill states. Up to now it was understood the NHI would only be rolled out once clinics and hospitals had been upgraded, not during the upgrade process. “The draft bill said a facility must be quality accredited before NHI will contract or appoint. This is different,” said Klinck.

The NHI pilot sites all had additional NHI infrastructure and funding. None of them had hospitals and clinics that passed the Office of Health Standards and Compliance (OHSC) inspections. So, the report asks, if focused effort and funding does not even fix the system, how do they plan to do it?

Health consultant Johan Serfontein said in the report that quality improvement needed to take place before the NHI was rolled out. “The NHI pilot sites all had additional NHI infrastructure and funding. None of them had hospitals and clinics that passed the OHSC inspections. So, if focused effort and funding does not even fix the system, how do they plan to do it?”

The report says asked if fixing the system while rolling out the NHI contradicted the NHI Bill, Professor Alex van den Heever of the Wits School of Governance said the NHI policy was not coherent. “To ask for consistency is a tough call.”

The report says a day before the State of the Nation address, the head of health at Section27, Sasha Stevenson that the NHI policy was unclear. They haven’t come up with a coherent NHI plan in 10 years. Changing offices won’t fix that.

Stevenson points out that the NHI is a fund that will buy health services, but this would not fix problems in the health system such as crumbling infrastructure and staff and drug shortages. “People are losing their lives every single day while we fixate on the passage of an NHI Bill that says little about quality and instead is focused on the creation of a fund. Health financing is a vital component of health system improvement, but the creation of a fund does not itself improve the health system.”

The report says Ramaphosa also mentioned a war room set up to design NHI policies. “Realising the magnitude of the challenges in healthcare, we have established an NHI and quality improvement war room in the presidency consisting of various key departments to address the crisis in the public health system while preparing for the implementation of the NHI,” he said. The war room is led by Dr Olive Shisana and is in the presidency buildings.

However, the report says, van den Heever was critical of the war room process. Russel Rensburg, spokesperson from the Rural Health Advocacy Project, questioned why the national Health Department was not driving the warn room.

Van den Heever said the NHI, as it stood, was like Brexit: a policy that did not have an implementation plan and “undermined the very health system” it planned to fix.

The report says neither the Presidency nor the Health Department responded to requests for comment.

Solidarity’s Occupational Guild for Health Practitioners has expressed their deep-seated concern about Ramaphosa’s statement that the NHI Bill will be submitted to Parliament soon. This follows after a version of the Bill was rejected by the cabinet at the end of last year due to various deficiencies. It also provoked heavy criticism with regard to funding, especially from the Treasury.

Morné Malan, senior researcher at the Solidarity Research Institute, explained that despite the fact that the final version of the bill is not yet available, one can reject such a policy from the outset. “The fact remains that nationalised healthcare is not workable. It is not economically viable, nor is it practically feasible. The shortcomings in the previous versions of the bill were profound and omnipresent. It is unthinkable that all the issues could have been solved in this version” Malan said.

Solidarity advises Ramaphosa to do away with this backward policy that has led to poorer health outcomes time and time again, irrespective of where attempts have been made to implement it. “The NHI will make South Africans as a whole sicker and leave them poorer. Health practitioners who choose not to emigrate will be even more adversely affected under the NHI system.”

Malan concluded: “Mr Ramaphosa proudly announced several figures and details about investments and government spending. However, very little information was given about the expected costs and realities regarding the NHI. South Africa is experiencing a crisis in health care. This crisis stems from the government’s inability to manage health care. Obviously, it is madness to think that the solution for this crisis lies in the state taking over the responsibilities of the current outstanding private healthcare sector. Incompetence cannot be cured by laying claim to more power for yourself. People cannot be cured by means of pretty words and pseudo-saintliness.”

Rampaphosa said in his address that key NHI projects targeting society’s most vulnerable people would begin in April. Business Day reports that he also announced that the government would launch a major cancer campaign within the next three months, similar to the government’s massive HIV/Aids counselling and testing campaign. It would draw on the private sector, he said. “We need to mobilise all resources to fight this disease,” he said.

He also emphasised the government’s commitment to combating South Africa’s HIV/Aids epidemic, promising to provide treatment to another 2m people by 2020.

The South African Communist Party (SACP) said it welcomed the announcement to decisively press ahead with the introduction of the NHI scheme on a report on the Politicsweb site. The SACP said: “We fully support the solidarity model announced by the President; namely, that the young should subsidise the old, the well-off should subsidise the needy and the healthy should subsidise the sick. In particular, the National Health Insurance should uproot inequalities in, and equalise access to quality healthcare.”

Meanwhile, Ramaphosa’s ambitions of devising a plan for fixing the health system have once again been delayed, as participants from last year’s health summit say they need more time to do a proper job. Business Day reports that Ramaphosa convened the two-day summit in late October, where delegates discussed ways to tackle the crisis in South Africa’s health system.

The report says the summit ended with a promise to craft a health compact by 10 December, but late last year that deadline was pushed out to the end of January 2019 after some stakeholders, including healthcare professionals, said the time-frame was too short. It has now emerged that work on the compact, which is expected to contain concrete steps for improving South Africa’s health system, is still under way.

“We have given ourselves more time to do this properly, because we think it is important to find solutions we all support and can action. We are looking for tangible, action-oriented outcomes,” Business Unity SA (Busa) CEO Tanya Cohen is quoted in the report as saying. Busa is one of the key constituents represented on the steering committee driving the process to craft the compact.

“What we haven’t done is engage on the legislation that is before the National Economic Development and Labour Council (Nedlac) and will go to parliament. We have been focusing on the crisis,” she said, referring to the National Health Insurance (NHI) Bill, which contains the first legal steps for realising the government’s ambitions of universal health coverage.

The report says Cohen made her remarks at a press briefing called by the presidency to report back on the work of the health summit. In a speech delivered on his behalf by health minister Aaron Motsoaledi, Ramaphosa said improving the health system and introducing NHI went hand-in hand, describing them as “two sides of the same coin”.

NHI aims to provide quality health services to everyone that is free at the point of delivery and is founded on the social solidarity principle that the rich and healthy subsidise the poor and the sick.

“Repairing our national health system is an endeavour that requires the input, involvement and innovation of all role-players who understand that good health makes for a good life and a good economy,” said the president.

SABC NEWS The health minister says there is a realisation among many countries that quality health care is crucial for economic growth.

President Cyril Ramaphosa says the country’s health system is at a tipping point and something should be done urgently to save it from collapse.

This in a speech delivered on his behalf by the Minister of Health at Tuynhuis to launch the Presidential Health Summit Report.

Minister of Health Dr Aaron Motsoaledi says, “Having identified critical challenges the summit called on government to urgently prioritise the filling of critical vacancies. The summit tasked the national treasury to develop a sustainable financing model and to prioritise the financial resources allocation to ensure the delivery of public health care is not compromised.”

The health minister says there is a realisation among many countries that quality health care is crucial for economic growth.

It’s estimated that South Africa spends about 8% of its gross domestic product (GDP) on healthcare.

“If healthcare is not taken care of, especially in the financing therefor, many economies may be down on their knees,” says Motsoaledi.

Doctors say they are ready to help to revive the country’s health system.

Dr Angelique Coetzee from SA Medical Association Chairperson says, “We from the medical profession had to get on the train and take this journey because otherwise if we stay on the station we will never be able to influence anything going forward.”

The long awaited National Health Insurance Scheme is widely seen as the antidote to the ailing public health system.

Health minister Aaron Motsoaledi on Tuesday said the government was taking a significant step towards universal health coverage that will bring quality health care to all South Africans.

Motsoaledi said the National Health Insurance (NHI) bill will soon be ready for submission to Parliament.

“After extensive consultation, the NHI bill will soon be ready for submission to Parliament. The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities,” the minister said.

Motsoaledi was speaking on behalf of President Cyril Ramaphosa in Cape Town on Tuesday during the launch of the report on the presidential health summit 2018.

The Summit took place in Ekurhuleni in October last year under the leadership of Deputy President David Mabuza, who officiated in Ramaphosa's absence. The theme for the Summit was: “Strengthening the South African health system towards an integrated and unified health system”.

The theme reflects the commitment in the national development plan to a sustainable quality health system that provides equal access and care to all South Africans.

President Ramaphosa indicated in the State of the Nation Address that in 2019 the country will take a significant step towards universal health coverage that will bring quality health care to all South Africans.

The NHI delivery model will be based on the primary health care approach, which emphasises the importance of providing preventative, promotive, curative, promotive and rehabilitative services.

“By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care. Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement ‘war room’ in the Presidency.

“This ‘war room’ brings together various key departments to address the crisis in the public health system while preparing for the implementation of the NHI. We are guided by the insight that improving the health system and introducing NHI are two sides of the same coin and are mutually reinforcing,” Motsoaledi said, adding that repairing South Africa’s national health system was an endeavour that required the input, involvement and innovation of all role players who understand that good health makes for a good life and a good economy.

BIZCOMMUNITY President Cyril Ramaphosa indicated in his State of the Nation Address (Sona) last week that in 2019 government will take a significant step towards universal health coverage that will bring quality

The National Health Insurance (NHI) delivery model will be based on the primary healthcare approach, which emphasises the importance of providing preventative, promotive, curative, promotive and rehabilitative services.

"By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care. Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement war room in the Presidency.

President Cyril Ramaphosa announced that he has established a war room in the Presidency to deal with the country's healthcare crisis and the National Health Insurance (NHI).

“This war room brings together various key departments to address the crisis in the public health system while preparing for the implementation of the NHI,” said Health Minister Aaron Motsoaledi.

He added that government is guided by the insight that improving the health system and introducing NHI are two sides of the same coin.

He said after extensive consultation, the NHI Bill will soon be ready for submission to Parliament.

Role player Involvement

“The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities.

“Repairing our national health system is an endeavour that requires the input, involvement and innovation of all role players who understand that good health makes for a good life and a good economy.

“At a time when we are laying the foundations for increased investment in our economy and we are developing the skills of our people to be active in this economy, it is essential that we build and maintain a healthy nation,” he said.

Motsoaledi’s remarks and the launch of the report come after the health sector held a summit in Ekurhuleni in October 2018. Deputy President David Mabuza officiated the summit under the theme: "Strengthening the South African health system towards an integrated and unified health system”.

During the summit, concerns were raised about the poor quality of healthcare that people experience in clinics and hospitals during their moments of vulnerability.

The complaints varied from inadequate access to medicines and equipment; inadequate numbers of staff at facilities; the unprofessional conduct of staff as well as labour unrest; corruption and theft of hospital property.

High cost of private healthcare

One of the barriers to access to healthcare, said the minister, is the unsustainably high cost of private care.

“Many users of this care experience above-inflation increases in medical schemes contributions, and the failure of medical schemes to pay for patient services that have been rendered.

“Several organisations have raised concerns with me regarding the dysfunction of the health system, to the point that it is clear that the system is in crisis and needs urgent rehabilitation. These are issues that must be addressed collectively by all stakeholders if we are to prevent a collapse of our health system,” he said.

There was a need for a robust, efficient and caring health system in a country where more than seven-million people live with HIV; rising rates of diabetes, hypertension and cancer; and where maternal and neonatal death rates must be reduced.

Health sector drafting a compact to improve health outcomes

Motsoaledi said that last year’s summit proposed a centralised, national procurement system, which will achieve economies of scale and assist in addressing corruption.

The success of a quality health system rests on information systems that can generate valid information at the right time and in the right format for decision making and monitoring at all levels of management, taking into account the need for patient confidentiality.

“Having identified critical challenges, the summit called on government to urgently prioritise the filling of critical vacant posts.

Sustainable financing model

“The summit tasked National Treasury to develop a sustainable financing model, and urged provinces to prioritise their financial resource allocation to ensure the delivery of quality health care is not compromised,” he said.

Motsoaledi said further proposals relate to the development of expertise and funding to implement government’s health infrastructure plan in a manner that will respond to changing population and clinical dynamics.

This, the minister said, demands stronger coordination between the Department of Health and partners such as the Department of Public Works.

The summit acknowledged the critical role the private sector has to play in the realisation of universal health coverage and the vision of the NHI, and called for inclusive process started through the summit to continue.

“Through this inclusive and collective approach, the Presidential Health Summit has pointed the way forward not only for health, but for other key sectors where inclusive engagement can make a great difference in the quality of life of South Africans.

“The summit has underlined once more the benefit of working together as a nation and building greater understanding through the involvement of a wide range of persuasions and expertise."

He said a Presidential Health Summit Compact, based on the summit's outcomes, was being put together which commits sectors to work together to implement identified solutions.

BHEKISISA Find out which issues have been prioritised after the Presidential Health Summit.

In 2018, President Cyril Ramaphosa held a three-day long Presidential Health Summit outside Johannesburg.

The gathering drew more than 100 representatives from civil society, government, unions, academia and the private sector. Before the event, each delegate received a 21-page concept note outlining challenges within the health system — this included corruption and how the NHI will incorporate the private sector.

Solutions proposed during the meeting will now form the basis for broader consultation ahead of a public plan to turn the health system. Although these solutions were set to be released in a 10 December 2018 compact, this document remains in draft form, Health Minister Aaron Motsoaledi said at the launch of the summit’s report on 12 February.

Read a copy of Motsoaledi’s remarks, delivered on behalf of Ramaphosa.

It is a very special moment for me to join all of you for the launch of the Report on the Presidential Health Summit 2018.

The Summit took place in Ekurhuleni on 19 and 20 October 2018 under the leadership of Deputy President David Mabuza, who officiated in my absence.

The theme for the Summit was: “Strengthening the South African health system towards an integrated and unified health system”.

This theme reflects the commitment in the National Development Plan to a sustainable quality health system that provides equal access and care to all South Africans.

The Presidential Health Summit 2018 gave us an opportunity to examine our national health system as a patient in its own right and to arrive at a diagnosis that would allow us to intervene and return this system to good health.

The Health Summit was able to give detailed attention to many of the issues with which I had been presented by various individuals and stakeholders since becoming President at the beginning of last year.

Many people have raised concerns and complaints with me about the poor quality of health care that people experience in our clinics and hospitals during their moments of vulnerability.

South Africans also complain of poor delivery of mental health services and delays in accessing health care.

One of the barriers to access is the unsustainably high cost of private care.

Many users of this care experience above-inflation increases in medical schemes contributions, and the failure of medical schemes to pay for patient services that have been rendered.

Several organisations have raised concerns with me regarding the dysfunction of the health system, to the point that it is clear that the system is in crisis and needs urgent rehabilitation.

These are issues that must be addressed collectively by all stakeholders if we are to prevent a collapse of our health system.

We need a robust, efficient and caring health system in a country where more than seven million people live with HIV, where we are seeing rising rates of diabetes, hypertension and cancer, and where maternal and neonatal death rates must be reduced.

Too many people do not receive quality preventive, promotive, curative and rehabilitative health care services.

As we itemise the challenges we face, we are encouraged by the gains we have made during 25 years of democracy in building a healthier nation.

According to the Medical Research Council’s Rapid Mortality Surveillance Report 2017, which was released a few days ago, average life expectancy in South Africa increased from 61.2 years to 64.2 years in the five years between 2012 and 2017.

The Survey also recorded declines in mortality among children under the age of five and among infants.

Neonatal mortality was unchanged during this five-year period, while maternal mortality declined by close to 30 percent.

In 2009, South Africa became the first country in Africa to introduce pneumococcal and rotavirus vaccines.

Five years later, the South African Medical Journal Reported a 64% reduction in rotavirus diarrhoea hospitalisations and a 46% reduction in hospitalisation for invasive pneumococcal disease in HIV-negative children older than 16 weeks of age.

While we have made much progress, there is much more we need to do.

Our efforts to restore our health system are informed by two of the five national priority tasks I outlined in the State of the Nation Address just a few days ago.

One of the tasks is to improve the conditions of life for all South Africans, especially the poor.

The other is to strengthen the capacity of the state to address the needs of the people.

I indicated in the State of the Nation Address that in 2019 we will take a significant step towards universal health coverage that will bring quality health care to all South Africans.

After extensive consultation, the NHI Bill will soon be ready for submission to Parliament.

The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities.

The NHI delivery model will be based on the primary health care approach, which emphasises the importance of providing preventative, promotive, curative, promotive and rehabilitative services.

By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care.

Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement ‘war room’ in the Presidency.

This ‘war room’ brings together various key departments to address the crisis in the public health system while preparing for the implementation of the NHI.

We are guided by the insight that improving the health system and introducing NHI are two sides of the same coin and are mutually reinforcing.

Repairing our national health system is an endeavour that requires the input, involvement and innovation of all role-players who understand that good health makes for a good life and a good economy.

At a time when we are laying the foundations for increased investment in our economy and we are developing the skills of our people to be active in this economy, it is essential that we build and maintain a healthy nation.

This is not a responsibility that rests only on the shoulders of delegates and partners to the Presidential Health Summit 2018.

This is a responsibility that must be exercised by all South Africans, who are called upon to adopt healthy and active lifestyles and to take care of their physical and mental wellbeing.

Our measure of success should not be rising levels of treatment for highly preventable conditions, but it should be the reduction of the incidence of such conditions in our society.

The Summit adopted the principle of ‘One Country, One Health System’ and welcomed the renewed energy and commitment within government to improve the health system.

The Summit generated unanimous support for National Health Insurance and for the principles of universal quality health coverage, social solidarity and equity in health access.

The NHI aims to embed the principle that health care services will be based on clinical need and not the ability to pay.

Health care will therefore be free at the point of service.

The Summit proposed a centralised, national procurement system, which will achieve economies of scale and assist in addressing corruption.

The success of a quality health system rests on information systems that can generate valid information at the right time and in the right format for decision making and monitoring at all levels of management, taking into account the need for patient confidentiality.

Having identified critical challenges, the Summit called on Government to urgently prioritise the filling of critical vacant posts.

The Summit tasked National Treasury to develop a sustainable financing model, and urged provinces to prioritise their financial resource allocation to ensure the delivery of quality health care is not compromised.

Further proposals relate to the development of expertise and funding to implement government’s health infrastructure plan in a manner that will respond to changing population and clinical dynamics.

This demands stronger coordination between the Department of Health and partners such as the Department of Public Works.

Overall, infrastructure in both the public and private health sectors must meet the requirements of the Office of Health Standards Compliance.

The Summit acknowledged the critical role the private sector has to play in the realisation of universal health coverage and the vision of the NHI, and called for inclusive process started through the Summit to continue.

Most importantly, health care users need to be active engaged in the processes of unifying the health system and Community Health Workers need to serve as a vital link between communities and health facilities.

The Summit derived its historical importance from the fact that this was the first time that such a rich diversity of stakeholders collectively confronted long-standing challenges in health and collectively devised measures that will overcome these challenges.

Through this inclusive and collective approach, the Presidential Health Summit has pointed the way forward not only for health, but for other key sectors where inclusive engagement can make a great difference in the quality of life of South Africans.

The Summit has underlined once more the benefit of working together as a nation and building greater understanding through the involvement of a wide range of persuasions and expertise.

The Report we are launching today serves the dual purpose of documenting the Summit deliberations for the purpose of setting implementation in motion.

At the same time, it provides guidance to the many millions of South Africans who could not attend the Summit and who – in the spirit of Thuma Mina – wish to know what role they can play in our health revolution.

Representatives of the Summit sectors are currently developing a Presidential Health Summit Compact based on the outcomes, which commits sectors to work together to implement identified solutions.

Representatives will consult their key constituencies on the interventions to be implemented and craft a plan that includes clear objectives, methods, timelines, indicators and financial resources.

I call on all South Africans to study this report with a better future in mind, and to identify ways in which we can enrich the outcomes of the Summit and set our nation on the road to good and sustainable health.

I wish to thank Deputy President David Mabuza, the Minister of Health, Dr Aaron Motsoaledi, my Special Advisor on Social Policy Dr Olive Shisana and the convenors of the Presidential Health Summit 2018 for creating a platform from which we will launch quality and universal health coverage that will benefit our entire nation.

I wish to thank all the participants for their contributions to the robust debate and the constructive outcomes.

Lastly, I wish to thank the media for covering and commenting on our transformation of the national health system.

Information is a vital part of empowering citizens to contribute to, and benefit from, the change we are realising in our country.

The Presidential Health Summit 2018 has generated a wealth of ideas.

Now we must act on these ideas and together ensure effective implementation.

There is a great deal of work ahead, but if we proceed in the spirit, and with the determination, with which we have started, I am certain that we will succeed.

SUNDAY TIMES Aaron Motsoaledi, the minister of health, has hauled the Hospital Association of SA (Hasa) over the coals, saying it is using fear mongering to fight the implementation of National Health Insurance (NHI).

This comes after the association's warning last week at Business Unity SA's Business Economic Indaba that thousands of jobs were at stake due to contradictions in the NHI and Medical Schemes Amendment Bills.

"Now they are saying 'if you implement the NHI, you are going to lose jobs'. So this is targeted at the trade union movement to start fighting us," Motsoaledi said on Thurs day night after President Cyril Ramaphosa's state of the nation address.

Hasa's presentation at the indaba was based on research it commissioned from Econex, whose findings were based on two scenarios that would have an effect on SA's economy.

The first scenario suggested that the government would not approach private hospitals to purchase services, which would result in the loss of 99,600 jobs in the private sector. The second scenario found that capping prices at 23% as per regulation would result in 132,000 job losses, according to Business Day. Motsoaledi also accused Hasa of using the threat of job losses to stymie the work of the health market inquiry HMI chaired by former chief justice Sandile Ngcobo that is looking into features of the private health care sector that prevent, distort or restrict competition.

"His Ngcobo's preliminary inquiry is yes, this pricing for health care is exorbitant, it needs to be regulated. They Hasa know that it might come up in the final report. What instrument do you use to fight it? Jobs, to get people to stop Ngcobo. In other words, South Africans must believe that for them to get jobs, health care must be expensive. What type of logic is that?" asked Motsoaledi.

He added that the NHI was for the whole country and the public sector would purchase services from the private sector. He also lashed out at Econex, saying: " They are guns for hire ... Anybody who hires them to do research, they will produce the results that person wants. I'm very angry with them when they do flimsy research and start fear mongering." The HMI released its preliminary report last year and is set to release the final version this year. Both Motsoaledi and his spokesperson, Popo Maja, said they had not seen the Econex report.

Hasa and Econex declined to share the research with Business Times, citing confidentiality.

After the media report and Motsoaledi's comments, Hasa denied it had said the NHI a posed a threat to jobs and said it was instead referring to "many economic sectors".

Hasa spokeperson Mark Peach said: "The central question addressed at the Business Economic Indaba was how we can together private and public sector stimulate national economic growth. Participants also addressed economic growth constraints. "One such constraint is policy uncertain ty, not only for health care but for many economic sectors.

The Hasa presentation covered the draft Medical Schemes Amendment Bill and the NHI Bill and the ways the two bills contradict each other and con tribute to policy uncertainty." The contradictions were with regards to the Medical Schemes Amendment Bill, which stipulates that medical aid schemes will not offer benefits offered by the NHI fund.

Peach said the question was whether this meant medical aid schemes will not covering the bulk of private hospitalisation. He also raised a question about what the purchasing of hospital services in the NI meant since the NHI Bill states that the NI Fund will purchase hospital services exclusively from the public sector until the end of 2026. It is not clear what happens thereafter.

Paula Armstrong, a senior economist Econex, said: "There is substantial uncertainty about the future format of health ca provision under NHI, and the NHI Bill are Medical Schemes Act Amendment Bill contradict each other in ways that have significant ramifications for the private sector."

In his state of the nation address Ramaphosa said the NHI Bill would soon ready for submission to parliament. Motsoaledi has previously said that NHI will be implemented in 2030.

EWN The association says without their salaries doctors are unable to pay for transport to report for duty.

The South African Medical Association says unpaid doctors will not show up for work until their January salaries have been paid.

The association says without their salaries doctors are unable to pay for transport to report for duty.

The no-show includes 48 health care professionals from various hospitals and clinics in Gauteng, five from the Eastern Cape and several others from various provinces.

The organisation says a total of 222 professionals from Gauteng alone have not been paid.

The associations Eddie Ngwenya says, “All doctors who are not yet paid; rather, all healthcare professionals who are still not paid will be put on special leave, understanding that they’re unable to reach work.”

HEALTH-E NEWS The Life Esidimeni tragedy, patient abuse and suicide by health professionals are among the issues pointing to a dire need for better management of public sector psychiatry.

This is the opinion of incoming South African Society of Psychiatrists president, Professor Bonga Chiliza, who has spoken out about the need for improvements in an area of health that has been neglected.

Now the newly-elected president of SASOP, Prof Chiliza said the deaths of 144 patients in the now-notorious Life Esidimeni tragedy; allegations of abuse and human rights violations at the Tower Psychiatric Hospital in the Eastern Cape and the suicide of UCT Health Sciences Dean Professor Bongani Mayosi all pointed to the need for the organisation to “rise and answer the call for advocating on behalf of mental health care users and our profession”.

Chiliza, who heads the Psychiatry Department of the University of KwaZulu-Natal (UKZN) Medical School and will serve as SASOP president until 2020, said the organisation would ramp up it’s lobbying for mental health care to be allocated an equitable share of the national health budget.

He said SASOP would also be doing more to encourage medical students to specialise in psychiatry, in order to grow the numbers of qualified professionals able to serve the country’s mental health care needs.

“Mental health conditions are often misunderstood, mismanaged and stigmatised, particularly for those who rely on the public health system for treatment. They are extremely vulnerable to abuse and SASOP as the professional body for psychiatrists must take the lead in ensuring better services to our people.

“We will live out the promise we made to society when we engaged in a social contract with our community as practising, professional psychiatrists,” he said.

Chiliza said SASOP was establishing a “robust Public Sector Executive Committee of senior psychiatrists in academia and government services” to guide its efforts to strengthen psychiatric care in the public health sector.

He said SASOP would continue its leading role in the National Mental Health Alliance of NGOs in the mental health care sector as a vehicle for advocacy on policy and budget issues affecting mental health care and the provision of professional psychiatry services in the public sector.

Outlining his vision for SASOP and its contribution to psychiatry, Chiliza said the organisation would also focus on renewing its leadership transformation efforts, strengthening the relationship between public and private sector psychiatry, and supporting early-career psychiatrists.

“We will re-energise our efforts to transform the leadership of SASOP and psychiatry in general. The leadership of SASOP will continue to transform until is aligned with the demographics of South Africa and is able to fully engage with issues that plague our country such as racism, sexism and other forms of discrimination,” he said.

Chiliza said that as a scarce resource, psychiatrists in the public and private sectors needed to work together, especially in preparing for the reorganisation of the health care system with the implementation of National Health Insurance (NHI).

“We are already piloting value-based care models in the private sector. There is no reason why these pilots cannot be performed in both private and state sectors,” he said.

On early-career psychiatry, he said he aimed to grow SASOP by focusing on young psychiatrists, registrars and medical officers, ensuring that young doctors had ample opportunity to do internships in the discipline and “fall in love with psychiatry”.

“We need to push harder for psychiatry to be truly recognised as a major discipline in undergraduate medical education,” he said.

Prof Chiliza said SASOP would look to increase the support it already offers to medical registrars in order to “facilitate a more equitable training platform for all registrars regardless of the university at which they are training”.

Support for early-career psychiatrists would also extend to assistance in dealing with professional practice issues such as billing, and mentorship for young psychiatrists and future academics.

FIN24.COM President Cyril Ramaphosa says the National Health Insurance (NHI) Bill will soon be ready for submission to Parliament.

"The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities.

"By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care," he said.

"Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement War Room in the Presidency consisting of various key departments to address the crisis in the public health system while preparing for the implementation of the NHI.

"We have a funded national quality health improvement plan to improve every clinic and hospital that will be contracted by the NHI.

"By introducing the NHI together with a multi-pronged quality improvement programme for public health facilities, we are working towards a massive change in the health care experience of South Africans," Ramaphosa said.

The president was delivering the State of the Nation Address (SONA) in Parliament on Thursday night. It is the 25th SONA of a democratic South Africa.

Last year Ramaphosa said the wheels would start turning on NHI - a policy to ensure access to universal health coverage.

NHI is a proposed state-run health financing system that aims to pool funds to provide access to quality health services for all South Africans regardless of their economic status. The Medical Schemes Bill is aligned to the NHI Bill, Fin24 reported previously.

BUSINESS DAY However, in his Sona, Ramaphosa did not say the contested bill had been approved by the cabinet, suggesting further work may still be done on it before it is considered by MPs

The long-awaited National Health Insurance (NHI) Bill will soon be submitted to parliament, President Cyril Ramaphosa promised in his state of the nation address (Sona) on Thursday night.

However, he did not say that the fiercely contested bill had been approved by Cabinet, which suggests further work may still be done on it before it is considered by SA’s legislators.

“This year, we will take a significant step towards universal access to quality healthcare for all South Africans. After extensive consultation, the NHI Bill will soon be ready for submission to Parliament,” Ramaphosa said in his speech.

“By introducing the NHI together with a multipronged quality improvement programme for public health facilities, we are working towards a massive change in the healthcare experience of South Africans,” he said.

Even if the bill is poised to be tabled in parliament, MPs will not have enough time to process it before the upcoming election in May, as it will have to be considered by both the National Assembly and the National Council of Provinces. Both houses of parliament are expected to hold public hearings on the bill.

The ANC-led government has been pushing NHI, its policy for achieving universal health coverage, since 2009, but has yet to drive through any concrete reforms to breathe life into its vision. The bill is significant because it is the government's first piece of enabling legislation for NHI. It aims to establish a fund that will purchase services from accredited public- and private-sector providers, and has potentially far-reaching implications for the entire healthcare system.

The NHI Bill was released for public comment in June, and became mired in controversy towards the end of 2018, after a leaked Treasury letter exposed an attempt by Ramaphosa’s adviser, Olive Shisana, to make sweeping changes to the draft bill. A revised version was rejected by the cabinet in early December, and then reconsidered at its most recent sitting on January 30.

Ramaphosa briefly mentioned the Presidential Health Summit he convened in 2018 to discuss the problems confronting SA's health system, but did not provide any details of what it had achieved so far. Nor did he announce any new and immediate steps to tackle the crisis, an omission likely to disappoint activists who earlier this week called on him to focus on fixing the crisis in SA’s health system, rather than driving policies that had yet to bear fruit.

BUSINESS DAY Ahead of President Cyril Ramaphosa's state of the nation address on Thursday, health activists have called on him to take concrete action to fix the health system rather than focusing on the long-promised national health insurance (NHI) scheme.

The ANC-led government has been pushing for NHI since 2009, but has yet to drive through any reform to breathe life into the policy, which aims to provide everyone with health services that are free at the point of delivery.

“SA has been on the brink of major health system change for almost a decade. NHI has been discussed for years and made less tangible with each iteration of the policy,” said lobby group Section 27, referring to the three NHI policy papers published by the government.

The first legislative steps towards establishing NHI are contained in the NHI Bill, which was published for public comment last June. The bill paves the way for the establishment of an NHI Fund that will purchase services from accredited public and private sector providers.

It has been mired in controversy, after a leaked Treasury letter exposed an attempt by the president’s adviser, Olive Shisana, to introduce sweeping changes to the proposed laws after the public comment period closed. The cabinet rejected a revised version of the bill in December, and reconsidered last week, but the government has remained tight-lipped about its content.

Section 27 said government had become fixated on the NHI Bill, at the expense of fixing the health system.

“The creation of a fund does not itself improve the health system. The fund needs a system to buy services from. We do not have that system,” it said in a statement issued on Wednesday.

Section 27 welcomed the fact that the Special Investigations Unit was expediting investigations and prosecutions in the health sector, and the appointment of more public healthcare workers as part of the President’s economic stimulus package. But it said more needed to be done.

“We cannot afford to stop at a few interventions and the passage of a bill. This state of the nation address we call for real action to fix the health system. Stop killing babies and their mothers through health system failure,” it said.

However, SA’s biggest trade union federation, Cosatu, said its members wanted to see more rapid progress on NHI. “Our nurses, doctors and health workers need to see the government get serious about building the foundations for the NHI and fast-tracking its realisation. Yet all they see is austerity, having to work 48 hour shifts, lack of basic medicines and security, growing queues and poor infrastructure,” said its parliamentary spokesperson, Mathew Parks.

IT WEB The healthcare sector can make the most of its investments in technology by adopting solutions that are modular and can be easily integrated into existing systems.

The provision of high-value healthcare is the ultimate goal in the South African context, but how we're going to get there is the challenge.

Value in healthcare is simply ensuring better patient outcomes and more effective use of resources. Leon Wolmarans, Business Development Manager at Health Systems Technologies, believes a modular approach to healthcare IT is instrumental in delivering better value for patients, for healthcare providers and for the sector as a whole.

The South African healthcare sector is characterised by a legacy of outdated and mismatched organisational structures, management practices, patient mobility and payment models. Wolmarans explains the challenge faced: "If you consider the disparities between the types of IT resources that a rural clinic has at its disposal when compared to a private hospital in a city, it's easy to see how the concept of the two sharing any kind of information would be challenging, at best."

However, when the government's National Health Insurance (NHI) comes into effect, it will be essential for all healthcare providers to be able to share information about patients, their treatment and billing. Wolmarans says there are five layers to delivering high-value healthcare. While not all of these have to be implemented simultaneously, they are interdependent and mutually reinforcing.

"If you consider the changes the local healthcare sector has seen recently with the issuing of two new Bills to enable implementation of the NHI, which aims to make high-value healthcare more accessible for all residents, it's clear that private and public healthcare providers will be expected to collaborate, and this just won't be possible without implementing a health information exchange (HIE) that's inclusive of all participants in the healthcare sector."

All of the above rely on the implementation of IT platforms that are standards-based and are integrated with a national HIE.

The national HIE will allow for the sharing of patient information between providers, subject to privacy, confidentiality, access and consent being managed by the HIE.

The investment in the heathcare providers' existing systems is protected because the data is standardised via an interfacing mechanism to make it available and accessible via the health information exchange.

Individual healthcare providers can add extra modules as they see fit to improve the collection of clinical data. Wolmarans clarifies: "A health information exchange would normally be put in place at either provincial or national level, and every qualifying healthcare practitioner that falls under it would be able to participate in it. Commonly found constraints at local healthcare providers, such as staff and IT skills levels, Internet connectivity, power supply and access to devices, mean each facility has a different degree of readiness to go digital. If you implement the healthcare information exchange as an umbrella service, participants can engage at various levels."

"Using a flexible, modular concept for the solutions that participate within a healthcare information exchange enables hospitals and other participants of various levels of maturity, capacity and financial status to implement according to their individual profiles."

Three must-have qualities for this type of solution:

* Must be designed around a flexible modular concept that allows customisation; * Must meet evolving operational requirements and comply with government and private funding and service delivery regulations; and * Must be able to seamlessly integrate third-party systems, solutions and equipment using healthcare interoperability standards.

Factors such as increasing medical costs and emphasis on better administration, management and collection of revenue are driving the adoption of HIEs both internationally and closer to home, particularly at healthcare facilities in the Western Cape, says Wolmarans. "As the NHI comes closer to fruition, the benefits of participation in a health information exchange are likely to become evident to more and more hospitals, pharmacies and other providers, and this can only be achieved by digitally transforming their operations."

BIZCOMMUNITY There has been a lot of hype around the proposed National Health Insurance Bill, 2018 (NHI Bill) and the numerous implications for South African citizens. Little has been said, however, about how the NHI Bill will impact on the provision of medical aid benefits in the employee context.

The NHI Bill aims to enable access to free, universal, high-quality healthcare for all, by creating a single national health insurance fund. The NHI Bill will, once promulgated, centralise the procurement of medical supplies by the State. A key feature of the NHI Bill is the establishment of the National Health Insurance Fund (NHI Fund).

Membership of the NHI Fund will be mandatory for all South African citizens. Currently, the NHI Bill is silent in relation to how the contributions towards the NHI Fund will work, but the Department of Health has indicated that everyone that can afford to do so will be liable to contribute towards the NHI Fund. It appears that contributions to the NHI Fund would be in addition to any medical aid scheme premiums, if individuals should choose to remain members of a private scheme. It is envisaged that all healthcare will be accessed free of charge through the NHI Fund.

It has been suggested that one of the options for funding the NHI would be via a withholding tax, similar to Pay as You Earn (PAYE). This would then be paid over to the NHI Fund by the employer.

Accordingly, once the NHI Bill is promulgated, employers will most likely have to contribute towards the NHI Fund and it appears that they would no longer be expected to contribute to private medical aid schemes on behalf of their employees, unless they elect to make both contributions.

Where an employer chooses to cease making private medical aid contributions on behalf of its employees, as a result of the introduction of the NHI Fund, this may result in a unilateral change to the employees’ terms and conditions or a potential unfair labour practice relating to the withdrawal of benefits. This is especially the case if the changes are not effected in the appropriate manner.

For those employees who decide to stay on a private medical aid scheme in addition to contributing to the NHI Fund, the draft Medical Schemes Amendment Bill has made several changes to the current system which appear to be advantageous for medical scheme members. It abolishes co-payments, requires medical aid schemes to make full payment of the patient’s expenses, and removes medical aid brokers. If these amendments are passed, medical aid scheme members who have raised concerns about above-inflation premium increases and exposure to co-payments should see immediate improvements. However, the changes could also potentially cause medical aid schemes to raise member contributions to cover their increased obligations.

While a substantial amount of detail is still to be fleshed out in the regulations, implementation of the NHI is currently targeted for 2025. In the interim, employers should consider whether they would want to cease contributions to their employees’ private medical aid scheme. In order to potentially cap their (future) liability and curb any headaches associated with trying to escape double contributions later, employers should consider building the present value of their contributions into their employees’ gross remuneration packages, requiring them to facilitate their own medical aid membership in the future. The effect of this will, at the very least, mitigate financial risk concomitant with increased premiums following the promulgation of the NHI Act.

NEWS24 The release of a final report about the state of competition in South Africa’s private health sector has been delayed again. It was compiled by an inquiry panel made up of medical, legal and economic experts. The panel heard submissions from a range of stakeholders including members of the public, civil society organisations as well as private hospital groups.

The inquiry was set up under the auspices of the country’s competition authority in 2013. It’s remit was to investigate characteristics of the private health sector that may prevent, distort or restrict competition. Its preliminary report, released in July 2018, concluded, among other things that the sector was highly concentrated in the hands of a few major players. The final leg of work was to get inputs from various players on the initial findings before concluding the inquiry. The inquiry has cost tax payers R197 million so far.

Another delay of the report – which should have been released in March 2019 – is therefore bad news. The sooner South African authorities deal with the issues of anti-competitive behaviour in the private sector, the more likely access to quality health care will improve.

South Africa has a two-tiered health care system. The public sector is under-resourced and stretched while the private sector is highly sophisticated and expensive. Even though only 16% of the country’s population uses private health care, it nevertheless gets a large portion of the government’s health expenditure in subsidies.

At the same time, private health costs continue to balloon and fewer people can afford it.

The inquiry’s preliminary recommendations offered a clear agenda for how the private sector can become an integral part of the current national health system. There must be no more delays: if South Africa is to reach its lofty goal of universal health coverage, the report must be released and those recommendations adopted.

Key findings and recommendations

The inquiry examined three aspects of the private sector.

• Medical schemes through which people pay for private health services and the administrators who run them.

• Private facilities, such as hospitals and clinics.

• Medical doctors and specialists in the private sector.

The key preliminary findings and recommendations were:

• Medical schemes provide multiple plan options for cover without providing adequate information to understand what they cover, how the plans compare and what value the patients receive. As a result, consumers aren’t able to compare what schemes offer or choose plan options on the basis of value for money.

• There is a lack of transparency on the pricing of health care goods and services, standardised reporting of health outcomes and implementation of evidence-based guidelines and treatment protocols.

• Medical practitioners and specialists are concentrated in the private sector. As a consequence, there is time to over-service and inefficient use of expertise and time.

In light of these and other findings, the inquiry made a number of recommendations to remedy the situation.

These included putting measures in place to enable the Council for Medical Schemes, which regulates medical aids, to exercise more effective oversight.

In addition, to ensure that people who belong to medical aids get more comprehensive cover, the inquiry proposed that all medical schemes also offer a standalone standardised obligatory basic benefit option. The basic option would include a standard basket of goods and services and be comparable among schemes. This option would include cover for the prescribed minimum benefits, make provision for the treatment of these prescribed minimum benefits outside of hospital settings and add primary and preventive care.

And the inquiry recommended tighter regulation of the sector through the establishment of a dedicated health care regulatory authority. This would govern the number and distribution of doctors and hospitals to meet current and future needs. And it would ensure the development of clinical protocols as well as shape the structure of payment systems.

The inquiry also recommended that a centralised national licensing framework be introduced. This would accredit all health facilities including clinics, hospitals and GPs’ rooms. Another recommendation was to establish a price-setting mechanism.

Important

The recommendations are innovative and would go a long way toward making health care in the country more equitable. But South Africans will have to keep waiting to see if they actually bear fruit.

The latest development is that, due to a lack of funds, all the inquiry’s work has been suspended until the end of the financial year in March after which a new date for the release of the final report will be published in the Government Gazette.

It’s important that the inquiry is allowed to complete its task sooner rather than later. This is because its findings could have a bearing on a piece of legislation currently making its way through parliament – the Medical Schemes Amendment Bill. The bill proposes changes to medical scheme governance and benefit options. Reports suggested that the department of health wanted to wait for the outcome of the inquiry before finalising the bill.

The inquiry could also affect the National Health Insurance Bill which is meant to herald in universal health care. But the bill is mired in controversy. The most recent version was recently rejected by the country’s cabinet which instructed the national department of health department to review what’s been proposed.

Until the final report is released, South Africans must contend with a fragmented, poorly regulated and expensive health care delivery system.

Wezile Chitha is assistant dean of Strategic Affairs, Faculty of Health Sciences at the University of the Witwatersrand.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

National Health Insurance (NHI), which the government is pushing as the solution to SA’s health crisis, could lead to the loss of up to 132,000 jobs, according to the country’s private hospital groups.

NHI, spearheaded by health minister Aaron Motsoaledi, is the government’s policy for introducing universal health coverage and aims to ensure everyone has access to healthcare that is free at the point of service.

The Hospital Association of SA (Hasa), which represents the private hospital sector, was among the industry groups that presented their views on the risks to the economy at last week’s Business Unity SA (Busa) meeting.

The gathering brought together business and government leaders, who have been trying to forge a closer relationship under the auspices of the Public Private Growth Initiative spearheaded by former politician Roelf Meyer and Toyota Europe and Africa CEO Johan van Zyl.

Hasa commissioned economics consultancy Econex to analyse the potential effect of the National Health Insurance Bill and the Medical Schemes Amendment Bill, which were released for public comment last June.

It noted about R180bn is spent on private healthcare in SA each year, a third of which is spent on private hospitals. The three JSE-listed hospitals — Netcare, Mediclinic and Life Healthcare, which make up about two thirds of the sector — contribute about R55.5bn to GDP a year.

It provided two scenarios to illustrate the economy-wide effect of two different policy paths.

Scenario one combined the provisions of the two bills, and concluded that the state would not purchase any private hospital services under NHI. In this scenario, 99,600 jobs were lost in the private sector, and R31bn was shed from SA’s GDP.

Scenario two added in the effect of price regulation, with prices capped at 23% lower than they are at present. Under this scenario, 132,000 jobs were lost.

“The aim was to speak to the risks … and to say ‘be careful’,” said Hasa chair Melanie da Costa, who delivered the presentation. She said that the way the two bills had been drafted was contradictory and contributed to the policy uncertainty confronting the sector.

Hasa also warned that the lack of clarity around the role and composition of the private hospital sector would knock future investment and capital expenditure.

A revised NHI bill, which has yet to be made public, was discussed by the cabinet last week. Motsoaledi’s spokesperson, Popo Maja, said the minister would not comment on the bill until after the president delivered the state of the nation address on Thursday.

The Medical Schemes Amendment Bill is expected to be revised after the Competition Commission’s health market inquiry publishes its final report later in 2019.

BUSINESS TECH There has been a lot of hype around the proposed National Health Insurance Bill (NHI Bill) and the numerous implications for South African citizens.

Little has been said, however, about how the NHI Bill will impact on the provision of medical aid benefits in the employee context.

This is according to Lauren Salt, an associate at Baker Mckenzie, who said that a key feature of the NHI Bill is the establishment of the National Health Insurance Fund.

“Membership of the NHI Fund will be mandatory for all South African citizens,” she said.

“Currently, the NHI Bill is silent in relation to how the contributions towards the NHI Fund will work, but the Department of Health has indicated that everyone that can afford to do so will be liable to contribute towards the NHI Fund.

“It appears that contributions to the NHI Fund would be in addition to any medical aid scheme premiums if individuals should choose to remain members of a private scheme. It is envisaged that all healthcare will be accessed free of charge through the NHI Fund.”

Salt said that it has been suggested that one of the options for funding the NHI would be via a withholding tax, similar to Pay as You Earn (PAYE). This would then be paid over to the NHI Fund by the employer.

Accordingly, once the NHI Bill is promulgated, employers will most likely have to contribute towards the NHI Fund and it appears that they would no longer be expected to contribute to private medical aid schemes on behalf of their employees, unless they elect to make both contributions, she said.

“Where an employer chooses to cease making private medical aid contributions on behalf of its employees, as a result of the introduction of the NHI Fund, this may result in a unilateral change to the employees’ terms and conditions or a potential unfair labour practice relating to the withdrawal of benefits.

“This is especially the case if the changes are not effected in the appropriate manner,” she said.

Private medical aid

For those employees who decide to stay on a private medical aid scheme in addition to contributing to the NHI Fund, the draft Medical Schemes Amendment Bill has made several changes to the current system which appears to be advantageous for medical scheme members, said Salt.

“It abolishes co-payments, requires medical aid schemes to make full payment of the patient’s expenses, and removes medical aid brokers. If these amendments are passed, medical aid scheme members who have raised concerns about above-inflation premium increases and exposure to co-payments should see immediate improvements,” it said.

However, the changes could also potentially cause medical aid schemes to raise member contributions to cover their increased obligations, she warned.

While a substantial amount of detail is still to be fleshed out in the regulations, implementation of the NHI is currently targeted for 2025, Salt said.

“In the interim, employers should consider whether they would want to cease contributions to their employees’ private medical aid scheme.

“To potentially cap their (future) liability and curb any headaches associated with trying to escape double contributions later, employers should consider building the present value of their contributions into their employees’ gross remuneration packages, requiring them to facilitate their own medical aid membership in the future.

“The effect of this will, at the very least, mitigate financial risk concomitant with increased premiums following the promulgation of the NHI Act,” she said.

BUSINESS REPORT Proposed merger in South Africa between Greif International Holding and Rheem South Africa, the two largest steel drum manufacturers in the country, has been prohibited by the Competition Tribunal.

It is the second proposed merger prohibited by the tribunal in two days after it on Wednesday prohibited a proposed merger between Mediclinic Southern Africa and Matlosana Medical Health Services in the North West province.

The tribunal said yesterday that the full reasons for its decision to prohibit the proposed merger between the two steel drum manufacturers would be issued in due course. The proposed merger, in terms of which Greif would acquire a majority interest in Rheem, was previously notified to the Competition Commission and prohibited in 2004. The basis for the commission's prohibition were materially the same in the current matter, with the.com mission finding it was likely that the merged entity would be able to unilaterally increase prices and remove an effective competitor from the market.

Greif and Rheem are both suppliers of industrial packaging products, including knock down drums for export, large steel drums and steel pails. Rheem has manufacturing facilities in Prospecton in Durban, Alrode in Johannesburg and in Cape Town, while Greif's main production sites are in Vanderbijlpark and in Mobeni in Durban.

The two companies notified the commission in March last year about the proposed intermediate merger. After investigating the matter, the commission in June last year prohibited the proposed merger on the grounds that the merger would constitute a near monopoly in the market for the manufacture and supply of large steel drums. The proposed merging parties applied to the tribunal in July last year for the matter to be reconsidered. Greif and Rheem argued the merger would not lead to substantial lessening of competition and there were alternative suppliers in the market.

They further argued that any potential competition concerns would be cured by the behavioural and or structural remedies they had proposed. The tribunal heard evidence from a number of witnesses, including experts, and engaged extensively with Greif and Rheem on whether a potential remedy could be found to address the commission's competition concerns. The proposed remedies were also canvassed with various stakeholders in the market. Despite the different remedies proposed, no appropriate remedy was proposed that would cure the substantial lessening of competition that would arise as a result of the proposed transaction.

BUSINESS DAY LIVE Women in the Eastern Cape’s OR Tambo district are 10 times more likely to die during pregnancy or childbirth than those in Joe Gqabi district.

The huge disparities in the healthcare services available to people living in different parts of the country were laid bare in the latest District Health Barometer, released on Thursday.

The District Health Barometer, published by the Health Systems Trust, is an annual publication that is now in its 13th edition. It is used by the government, academics and policy makers to track trends in the country’s public health system.

It showed barely half (55.7%) the babies living in Sarah Baartman district in the Eastern Cape were fully immunised, compared to almost all (97.7%) living in KwaZulu-Natal’s eThekwini district in 2017-2018.

The gap looms large even within provinces: women in the Eastern Cape’s OR Tambo district were 10 times more likely to die during pregnancy or childbirth than those in Joe Gqabi district: the institutional maternal mortality rate was 198.7 per 100,000 live births in OR Tambo and 20.3 per 100,000 live births in Joe Gqabi. The institutional maternal mortality rate covers women who die during pregnancy, childbirth or within 42 days of delivery.

The barometer showed district health service spending on HIV/AIDS programmes had steadily increased as a proportion of the total, from just 7.3% in 2004-2005 to just over a fifth (20.7%) in 2017-2019, reflecting the government’s steadily expanding treatment programme. SA has the world’s biggest HIV/AIDS epidemic, with about 4.2-million public-sector patients on treatment.

The report highlighted other overall improvements, such as a decline in mother to child transmission of HIV: the percentage of babies testing positive for HIV at 10 weeks fell from 1.3% in 2016-2017 to 0.9% in 201-2018. It also showed the proportion of pregnant women who made their first visit to an antenatal clinic before 20 weeks increased from 61.2% in 2015-2016 to 66.6% in 2017-2018.

The increase is linked to the national health department’s introduction of MomConnect in 2014, said the report’s authors. MomConnect supports pregnant women and mothers of young children using cellphone technology.

Almost 13% of all hospital births were to children and teenagers aged between 10 and 19. Alfred Nzo in the Eastern Cape had the highest rate of delivery among 10 to 19 year olds, at 24.7%, while Johannesburg had the lowest, at 4.7%.

The latest edition of the District Health Barometer can be found here.

THE CITIZEN The Competition Tribunal has prohibited a merger between Mediclinic and Matlosana Medical Health Services in North West.

In a statement, the Tribunal says the proposed merger should be prohibited on grounds that it would likely result in a significant increase in healthcare prices in the region. In addition, the Commission argued that the incentive to improve on non-price factors, such as patient experience and quality healthcare, would likely diminish after the merger. The Commission also argued that the acquisition would confer relatively greater bargaining power to Mediclinic vis-à-vis medical schemes.

The merging parties denied that the proposed merger would have any negative effects on competition and argued that it would lead to a number of pro-competitive efficiencies. This included improved costs of procurement and increased clinical quality and patient experience at the target hospitals.

In terms of the proposed merger, Mediclinic would have acquired a majority interest in MMHS that owns and operates two multi-disciplinary private hospitals, Wilmed Park and Sunningdale Hospitals, in Klerksdorp (the target hospitals).

“Mediclinic, one of the largest hospital groups in South Africa, owns and operates, inter alia, Mediclinic Potchefstroom which is located about 50km from the target hospitals. Mediclinic Potchefstroom, Wilmed Park and Sunningdale all provide inpatient private hospital services in the Klerksdorp and Potchefstroom area,” the Tribunal noted.

The Competition Commission was notified of the proposed merger in 2016. In June 2017, the Commission recommended to the Tribunal that the proposed merger should be prohibited on grounds that the joining together of Mediclinic Potchefstroom, Wilmed Park and Sunningdale hospitals would likely result in a significant increase in healthcare prices in the region.

The Tribunal engaged extensively with the merging parties on whether a potential remedy could be found to address the Commission’s competition concerns. The proposed remedies were discussed with a number of medical schemes that gave valuable inputs to the Tribunal.

“However, despite different proposed remedies put up by the merging parties over several months, no appropriate remedy was tendered that would cure the substantial lessening of competition that would arise as a result of the proposed transaction,” the Tribunal concludes.